Would compliance with cancer care standards improve survival for breast, colorectal and lung cancers?

McCarthy, Mark; Datta, Preeti; Khachatryan, Artak; Coleman, Michel P; Rachet, Bernard

doi:10.1136/jech.2007.066258

Cited by 26 publications

(15 citation statements)

References 15 publications

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“…Hence, systematic positive and linear relationship of adherence and survival is not replicable with incomplete multivariate models. In this sense, the present study is consistent with other reports [40, 41]. …”

Section: Discussionsupporting

confidence: 94%

The adherence paradox: guideline deviations contribute to the increased 5-year survival of breast cancer patients

2015

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BackgroundIn German breast cancer care, the S1-guidelines of the 1990s were substituted by national S3-guidelines in 2003. The application of guidelines became mandatory for certified breast cancer centers. The aim of the study was to assess guideline adherence according to time intervals and its impact on survival.MethodsWomen with primary breast cancer treated in three rural hospitals of one German geographical district were included. A cohort study design encompassed women from 1996–97 (N = 389) and from 2003–04 (N = 488). Quality indicators were defined along inpatient therapy sequences for each time interval and distinguished as guideline-adherent and guideline-divergent medical decisions. Based on all of the quality indicators, a binary overall adherence index was defined and served as a group indicator in multivariate Cox-regression models. A corrected group analysis estimated adjusted 5-year survival curves.ResultsFrom a total of 877 patients, 743 (85 %) and 504 (58 %) were included to assess 104 developed quality indicators and the resuming binary overall adherence index. The latter significantly increased from 13–15 % (1996–97) up to 33–35 % (2003–04). Within each time interval, no significant survival differences of guideline-adherent and -divergent treated patients were detected. Across time intervals and within the group of guideline-adherent treated patients only, survival increased but did not significantly differ between time intervals. Across time intervals and within the group of guideline-divergent treated patients only, survival increased and significantly differed between time intervals.ConclusionsInfrastructural efforts contributed to the increase of process quality of the examined certified breast cancer center. Paradoxically, a systematic impact on 5-year survival has been observed for patients treated divergently from the guideline recommendations. This is an indicator for the appropriate application of guidelines. A maximization of guideline-based decisions instead of the ubiquitous demand of guideline adherence maximization is advocated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1765-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 94%

The adherence paradox: guideline deviations contribute to the increased 5-year survival of breast cancer patients

2015

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“…Another study from Korea likewise found that compliance with consensus recommendations was significantly associated with better survival [18]. For other cancers such as colorectal cancer and lung cancer a correlation between compliance with cancer care standards and prognosis could be shown as well [19,20].…”

Section: Discussionmentioning

confidence: 94%

Quality Assured Health Care in Certified Breast Centers and Improvement of the Prognosis of Breast Cancer Patients

et al. 2011

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Background: Increasing effort has been put in the implementation and certification of breast centers in order to establish standardized, quality assured health care for breast cancer patients. The aim of this analysis was to investigate whether patients treated in certified breast centers (CBC) have a favorable prognosis as compared to patients treated outside of certified breast treatment units. Patients and Methods: The data of 3,940 patients with invasive nonmetastatic breast cancer were analyzed with regard to differences in patient and tumor characteristics and crude overall survival according to diagnosis in or outside CBC in Middle Franconia, Germany. Patient, tumor, and follow-up data were obtained from the clinical cancer registry. Results: Patients in CBC were younger, and had lower disease stages and lower grading. Independent of the effects of these variables on overall survival, being treated at a CBC added to the prediction of overall survival. Patients treated at a CBC had a hazard ratio of 0.70 (95% confidence interval 0.52–0.93) in the adjusted Cox model. Conclusions: Independent from common prognostic factors, diagnosis and treatment of breast cancer at a CBC improves the prognosis of patients. It can be hypothesized that this effect is mediated through quality assured health care provided by the certification process.

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“…One significant limitation of the study was that adherence to standards and survival data were aggregated across cancer networks and not analyzed at the hospital level. The benefit for higher multidisciplinary cancer care standard scores was seen with 1‐year survival but not 5‐year survival .…”

Section: Multi‐institution Studies Of Multidisciplinary Cancer Care Amentioning

confidence: 94%

“…Similarly, a nation‐wide study in England was completed by McCarthy et al to examine the association of adherence to multidisciplinary cancer care guidelines with survival in patients with breast, colorectal, and lung cancer . Higher total scores for multidisciplinary team standards were associated with improved survival for colorectal and lung cancers, but not for breast cancer . The authors found wide variation among hospitals for adherence to these standards.…”

Section: Multi‐institution Studies Of Multidisciplinary Cancer Care Amentioning

confidence: 99%

Multidisciplinary cancer care: Does it improve outcomes?

Brar

Hong

Wright

2014

Journal of Surgical Oncology

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Multidisciplinary care has been advocated as a solution for increasingly complex treatment decisions in cancer patients. The impact of multidisciplinary care on patient survival has been studied, but evidence is limited by poor methodological quality. Lack of conclusive evidence for increased survival is balanced against improvements in quality of care, guideline adherence, reduction in wait times, and greater satisfaction for patients and care providers.

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Would compliance with cancer care standards improve survival for breast, colorectal and lung cancers?

Abstract: This study suggests that compliance with some clinical service standards, such as guidelines, could contribute to better survival at population level, while more general organisational aspects of cancer services may not directly improve survival.

Cited by 26 publications

References 15 publications

The adherence paradox: guideline deviations contribute to the increased 5-year survival of breast cancer patients

The adherence paradox: guideline deviations contribute to the increased 5-year survival of breast cancer patients

Quality Assured Health Care in Certified Breast Centers and Improvement of the Prognosis of Breast Cancer Patients

Multidisciplinary cancer care: Does it improve outcomes?

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